Manual and diary

MANUAL AND DIARY

of practical training

(in surgery)

as assistant to first aid surgeon’s mate

for third year General medicine students

Volgograd State Medical University

A. A.Polyantsev General Surgery department

MANUAL AND DIARY

of practical training

(in surgery)

as assistant to first aid surgeon’s mate

for third year General medicine students

During their practical training as assistant to surgeon’s mate of first aid the students broaden their theoretical knowledge, acquire practical skills provided for by the syllabus, master ethical and deontological aspects of communication with patients and medical personnel.

The present manual is to give methodological aid to the student and to the supervisor of practical training in organising practical training as assistant to surgeon’s mate of emergency care.

The manual sets down the purposes and objectives of the practical training, the scope of practical skills, the format of recording and reporting; themes for health education and research are also offered.

PROGRAMME

of practical training for third year General medicine students

OBJECTIVE OF PRACTICAL TRAINING: To familiarise students with the work of first aid station, to help them acquire practical skills of giving emergency aid as required of surgeon’s mate of first aid station.

1. GENERAL QUESTIONS

Third year students of General medicine department go through this practical training as assistants to surgeon’s mate of first aid station after they have passed their winter exams.

The length of practical training is 72 hours.

During their practical training students discharge evening duty twice.

Students have their practical training at first aid stations of Volgograd.

The practical training is undertaken under the supervision of A. A.Polyantsev General Surgery department.

Immediate supervision rests with the head of first aid station. Students work as assistants to surgeon’s mate under the guidance of doctor’s and nurses of the emergency team.

Students keep diaries recording the work done during the time on duty.

The doctor (surgeon’s mate) under whose guidance the student works verifies the diary.

Upon completion of the practical training the head of first aid station writes a letter of reference for the student and certifies it with his seal.

On the last day of practical training the student submits the diary and a report to the supervisor of practical training. The student goes to an interview at the department after which he is given his mark (the questions to be discussed at the interview are given below).

LIST OF PRACTICAL SKILLS AND MAIPULATIONS

During Summer practical training students consolidate and perfect the attainments and skills acquired during classes at the department which correspond to the qualification of surgeon’s mate of emergency care.

№	List of therapeutic and diagnostic skills	Number	Quality of
knowledge	skills	attainments
1	Functional duties of paramedical personnel of emergency teams	8-10
2	Familiarisation with the admission procedure and paperwork when emergency team is called for	8-10
3	Statement of death; handling a dead body	1-2
4	ACUTE VASCULAR FAILURE: a) fainting b) collapse	5-10
5	(TOXIC) PULMONARY EDEMA: a) restoration of airway patency; b) countering hypoxia of tissues c) reducing the excitability of respiratory centre d) improving contractility of cardiac muscle e) indications for hospitalisation; peculiarities of transportation	5-10
6	Spontaneous pneumothorax, first aid	5-10
7	Diagnostics of consciousness impairment and comatose condition. Emergency aid prior to hospitalisation. Before-doctor care.	5-10
8	Diagnostics and emergency care in alcoholic, food, biological, industrial and other types of poisoning: a) familiarisation with the table of poisons and antidotes; b) b) antidote therapy and use of physiological antagonists of poisons; c) supportive therapy to normalise vital organs and systems; d) active elimination of absorbed and unabsorbed poison; e) prevention and treatment of secondary complications	8-10 8-10 8-10 8-10 8-10
9	Diagnostics of paroxysmal syndrome: emergency care	2-3
10	Nosebleed, oral haemorrhage, haemoptysis and pulmonary haemorrhage, haematemesis, gastric haemorrhage, melena	3-5
11	Clinical appraisal of haemorrhage type and extent of blood loss	3-5
12	Temporary arrest of external haemorrhage by mechanical means: a) application of tourniquet (of rubber, fabric, garrot); b) pressing on the artery; c) maximum flexure of extremity in the joint	3-5 3-5 3-5 3-5
13	Definitive haemostasis with a dressing	3-5
14	Determining indications for transportation and hospitalisation in blood loss and haemorrhage	3-5
15	Control of storage of blood substitutes	3-5
16	ABO blood grouping	3-5
17	Express-method of Rhesus-factor typing	3-5
18	Cross-matching donor’s and recipient’s blood for compatibility before transfusion	3-5
19	Monitoring the patient during transfusion of blood and blood substitutes. First aid in post-transfusion complications	3-5
20	Prescription, storage and transportation of infusion solutions	3-5
21	WOUNDS: a) appraisal of the state of wound; b) first aid to the wounded c) choice of local treatment of wound d) active and passive prevention of tetanus e) instrumental dressing of wound	3-5
22	Appraisal of type and extent of burn	2-3
23	Covering burnt area with bandage dressing	2-3
24	Covering burnt area with cravat dressing	2-3
25	Primary treatment of burnt area	2-3
26	Local administration of drugs depending on the stage	2-3
27	Aid in burn shock	1-2
28	Subcutaneous injections	15-20
29	Intramuscular injections	15-20
30	Intravenous injections	15-20
31	Blood-letting	3-5
32	Filling the intravenous infusion system	15-20
33	Preparing the instruments for tracheal intubation, tracheotomy	3-5
34	Catheterisation of bladder with rubber catheter	3-5
35	Gastric lavage with thick gastric tube	3-5
36	Administration of purgative, siphon enema, of flatus tube	3-5
37	Closed-chest cardiac massage	3-5
38	“Mouth to mouth” and “mouth to nose” artificial pulmonary ventilation. Use of respirator,
39	Different methods of oxygenotherapy (oxygen cushion, oxygen caddy, oxygen supply through foam-breaker)	10-15
40	Sputum suction (with rubber and plastic catheter through nose or mouth, airway, intubation and tracheotomy tubes)	3-5
41	Use of air-way to ensure patency of respiratory tracts	3-5
42	Application of dressing: a) sling bandage on the nose, chin, forehead, crown of head, back of head b) cravat bandage on the foot, hand, shoulder and femoral joint, chest, abdomen, buttocks, neck, head; c) roller bandage on the hand, foot, joints; spica bandage on the shoulder; spiral bandage on the chest; Desault’s bandage; capeline bandage on the head; bandage on the ear, eyes.	5-10 5-10 5-10
20	Applying Dietrich’s splint. Cramer’s splint on upper and lower extremity, immobilisation of head and cervical part of spine with Cramer’s splint or improvised materials	3-5
21	First aid upon drowning	1-3
22	First aid in closed injuries of soft tissues	1-3
23	First aid in dislocation, fracture	1-3
24	First aid in craniocerebral trauma	1-3
25	First aid in bites by poisonous snakes or insects	1-3
26	First aid in acute urine retention	3-5
27	First aid in hepatic colic, acute cholecystitis	3-5
28	First aid in renal colic	3-5
29	First aid in acute appendicitis	3-5

LIST OF QUESTIONS

for a credit for practical training

of 3rd year students of General medicine department

1. The main principles of providing emergency care in Russia.

2. Functional duties of medical personnel of mobile emergency teams.

3. Structure, organisation and work of first aid station.

4. Technique of taking body temperature.

5. Rules of transporting a patient.

6. Technique of drawing urine with rubber and metal catheter.

7. Technique of assembling dropping tube for intravenous infusion of a drug.

8. Technique of applying cupping-glasses (mechanism of their action).

9. Technique of applying mustard plaster (mechanism of its action).

10. Technique of applying a tourniquet on an extremity

11. Technique of administering purgative, siphon, therapeutic, nutrient enema.

12. Technique of subcutaneous, intramuscular injections.

13. Clinical presentations, diagnostics of post-injection complications.

14. Technique of intravenous infusion.

15. ABO blood grouping.

16. Rhesus-factor typing.

17. Blood testing before transfusion.

18. Blood transfusion.

19. Catheterisation of subclavian vein, care of subclavian catheter.

20. Technique of duodenal intubation.

21. Gastric intubation technique; investigation of gastric contents.

22. Gastric lavage technique.

23. First aid in shock, collapse, fainting.

24. First aid in post-transfusion reaction.

25. Causes of post-transfusion reactions; ways of preventing them.

26. First aid in allergic reaction upon administration of antibiotics.

27. Steps taken by medical personnel in emergency state (asphyxia, syncope).

28. First aid in eventration of abdominal organs.

29. Observation and care of patients with gastroenterological problems.

30. Observation and care of patients with respiration disorders.

31. Observation and care of patients with urogenital disorders.

32. Artificial lung ventilation and external cardiac massage.

33. Aspects of deontology in surgery.

34. Application of plaster splint.

35. First aid in spontaneous pneumothorax.

36. Certifying death, handling a dead body.

37. Pulmonary edema, its causes, treatment.

38. Restoration of patency of respiratory tract.

39. Combating oxygen deprivation.

40. First aid in acute alcoholic intoxication, intoxication with aggressive fluids.

41. Diagnostics and first aid in paroxysmal syndrome.

THEMES FOR REPORTS

(5-6 printed pages)

1. Venous pressure. Technique of taking venous pressure.

2. Purgative enema. Indications, technique of administration. Possible complications, their prevention.

3. Siphon enema. Indications, technique of administration. Possible complications.

4. Postoperative intestinal paresis. Its prevention and treatment.

5. Respiratory arrest. Its prevention, first aid.

6. Pleural puncture. Technique of administration, possible complications.

7. Paracentesis. Technique of administration, possible complications and their prevention.

8. Laparoscopy, indications and contraindications. Its clinical plications and their prevention.

9. Endoscopic methods of investigation of gastrointestinal tract.

10. Bronchoscopy: technique of administration.

11. Angiography. Technique of administration, diagnostic importance.

12. Proctosigmoidoscopy. Technique of administration, diagnostic importance.

13. Basic principles of parenteral nutrition in surgery.

14. On medical deontology and medical ethics.

15. Deontology in surgery.

16. Medical secret. Ethical and legal problems of betraying medical secret.

17. Basic principles of aseptics and antiseptics in surgery.

18. Cupping-glasses, mustard plaster. Indications and plications and their prevention.

19. Parenteral way of administering drugs. Its advantages and disadvantages. Possible complications, their prevention.

20. Urine retention. Technique of bladder catheterisation.

21. Intravenous administration of plications and their prevention.

22. Gastric intubation. Indications and plications and their prevention.

23. Gastric lavage. Indications and plications and their prevention.

24. Duodenal intubation. Indications, technique and clinical importance of the method.

25. Use of antibiotics in surgery.

26. ABO blood grouping. Errors in grouping, their prevention.

27. Haemotransfusion shock. Etiology, clinical presentations, diagnostics, treatment and prevention.

28. Hematocrit and central venous pressure. Methods of determining. Clinical importance.

29. Specifics of care of oncological patients.

30. Sterilisation of surgical instruments, optical equipment.

31. Autoclaving.

32. Prevention of errors in blood transfusion.

33. Methods of transfusing blood and blood products.

34. Ulcer. Clinical presentations, diagnostics, treatment.

35. Fistula. Diagnostics, treatment.

36. Parenteral nutrition.

37. Primary debridement of wound (indications, contraindications, methods of performing).

38. Management of suppurating wounds.

39. Types of local anesthesia. Indications, contraindications, methods of administering.

40. Organization of oncological care in Russia.

41. Prevention of tetanus.

42. Blood substitutes. Indications and contraindications for their administration.

43. Ultrasound investigation of liver and biliary tracts.

44. Resuscitation upon cardiac or respiratory arrest.

DIARY

Date	Patient’s name and age	Description of work	Supervisor’s signature

Reference

of student ______________________

Signature of Supervisor of training

Signature of Head of first aid station

Examination markb